Henry Ford Health System’s No Harm Campaign · 9/24/2018 1 Henry Ford Health System’s No Harm Campaign Martin Levesque, MPH, MBA, CIC, FAPIC System Director, Infection Prevention

9/24/2018

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Henry Ford Health System’s

No Harm Campaign

Martin Levesque, MPH, MBA, CIC, FAPIC

System Director, Infection Prevention and Control

Henry Ford Health System, Detroit, Mich.

Disclosures

¯\_(ツ)_/¯Nothing of significance to disclose…

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Henry Ford Health System

• A not-for-profit corporation

• 25,554 full-time equivalent

employees

• More than 31,000 total employees

• More than 7,400 nurses including

501 from Canada; more than 4,400

allied health professionals

• More than 117,000 hospital

admissions

• 61 percent of hospital admissions

are by patients ages 50 and older

• More than 74,800 surgical

procedures performed

• Payor distribution:

– Medicare and Medicare HMO, 42%

– Blue Cross, 25%

– Medicaid and Medicaid HMO, 17%

– Other, 16%

• Revenue, $5.98 billion; Net

income, $203.6 million;

Uncompensated care, $443 million

Source: Henry Ford Health System Fact Sheet, 2018, produced by the Public Relations Department

Henry Ford Health System

• Henry Ford Hospital

– 877-bed tertiary care hospital

– 10 ICUs (152 beds), NICU (35 beds)

– One of the largest teaching

hospitals in U.S.

– Level 1 Trauma Center

• Henry Ford Allegiance

– 365-bed Acute Care

– 14-bed ICU

– Level II Trauma

• Henry Ford Macomb

– 361-bed Acute Care

– 2 ICUs (48 beds)

– Level II Trauma

• Henry Ford West Bloomfield

– 175-bed Acute Care

– 3 ICUs (36 beds)

– All private rooms

– Level III Trauma

• Henry Ford Wyandotte

– 360-bed Acute Care

– 3 ICUs (82 beds)

– Level III Trauma

• Henry Ford Kingswood

– 100-bed inpatient psychiatric

– Children, adolescent, and

adults

Source: Henry Ford Health System Fact Sheet, 2018, produced by the Public Relations Department

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Henry Ford Health System’s

No Harm Campaign

Some history…

• Early in 2008, Henry Ford Health System launched a

three-year No Harm Campaign

• Initial goal to decrease patient and employee harm

events by 50 percent by 2010

• The broad scope of the “No Harm Campaign” uses an

approach to report and study harm events, research

causality, identify priorities, and change practice to

eliminate all harm to patients and staff.

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Some history…

• Since the start of the No Harm Campaign, System

leaders and employees have worked to build the

knowledge base and infrastructure required to implement

new process improvements to eliminate harm.

• All System hospitals, for example, must define, measure,

collect data, and analyze “harm events” in the same way

before new processes can be tested, verified, refined,

standardized, and spread throughout an organization for

lasting change.

• Harm (as we see it):

Any unintended injury resulting from

medical care that requires additional

monitoring, treatment or hospitalization,

or that results in death whether or not it is

considered preventable, resulted from

error or occurred in a hospital.

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Some history…

• Henry Ford identified its own broad agenda for harm

reduction in all Henry Ford facilities and a unique

aggregate harm score, which includes the following

measures of harm:

– Infection-Related Harm

– Procedure-Related Harm

– Medication-Related Harm

– Care Related Harm

– Other Preventable Harm• Health Care-Acquired Acute Renal Failure

• Employee Injuries

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• Infection Control

– BSI

– VAP

– UTI

– C-diff

– SSI

– Sepsis

• Employee Harm

• Other

– Renal Failure

– Blue Alert

– DVT

Data Sharing – System Level Dashboard

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Data Sharing – System Level

Data Sharing – Local Level

Newest member facility, Henry

Ford Allegiance, data started

streaming in July 2017…

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The Power of Sharing Data…

Drilling down deeper…

Spark Reports

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So How Does This Look

at the Front Line?

Example #1

Delivering Safe and Patient Focused

Care Through the Reduction of Hospital

Acquired Clostridium difficile using a

Multi-Disciplinary Approach

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The Challenge…

• Clostridium difficile infection (CDI) is one of the most

common healthcare-associated infections (HAI)

• According to the Center for Disease Dynamics,

Economics, and Policy…

– Cost per CDI - $11,285

– Attributable LOS – 3.3 days

– Contributes to increased morbidity and mortality

• Our Goal: Reduce CDI by 25% from previous year

Source: The Center for Disease Dynamics, Economics & Policy (CDDEP) (https://cddep.org/tool/overall_and_unit_costs_five_most_common_hospital_acquired_infections_hais_us/)

PDCA: PLAN

ENGAGE

Key Stakeholders:

Infection Prevention and Control

Environmental Services

Culinary Wellness

Antimicrobial Stewardship

Nurse Managers

Front Line Staff

Laboratory

Senior Leadership

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PDCA: PLANEDUCATE Providers and nursing on C. diff testing appropriateness

Heighten awareness of front line staff on implications and complications of CDI

EVS on the importance of environmental cleaning and disinfection

Front line staff on the importance of cleaning frequently used patient care items

and use patient dedicated equipment for isolation patients

House wide education on the importance of hand hygiene and coaching on

missed moments

Educate providers on increased CDI risk as an adverse effect of antibiotic over-

utilization

Raise awareness on the increased risk of CDI with proton pump inhibitor (PPI)

use

Staff and patients on yogurt as a probiotic

PDCA: PLAN

EXECUTE

Prioritize and target opportunities

Appropriate testing for C. diff

Antimicrobial Stewardship

Implementation of yogurt as probiotic

Increase hand hygiene compliance

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PDCA: PLAN

EVALUATE

Root Cause Analysis

Isolation Compliance

Data shared transparently at daily safety huddles

Dashboard reporting with comparison to last year data

PDCA: DO

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Isolation Compliance Monitoring

Correct

Isolation

Sign

Hand Hygiene Week ExcitementHand Hygiene

“Caught in the

Moment” Tokens of

Appreciation

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PDCA: DO

Post Huddle Working Board for HA C.

diff

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Targeted Approach of UV Robot

Patient Education/Information on Yogurt as Probiotic

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Staff Awareness and Empowerment

PDCA: Check

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As a System, Our C. diff progress

33% reduction since 2014!

PDCA: Check

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0

50

100

150

200

250

Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

3rd, 4th, 5th Gen CephsDays of Therapy/ 1,000 Patient Days

WYN MAC WB DET

Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

WYN 149.34 166.33 159.67 147.75 121.75 118.59 113.93 106.14

MAC 149.38 160.07 140.88 125.68 128.87 142.34 136.49 130.59

WB 189.92 204.3 188.68 175.11 173.2 187.25 156.74 143.17

DET 181.05 176.22 179.41 111.23 110.97 152.79 134.66 127.87

0

10

20

30

40

50

60

Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Quinolone Days of Therapy/ 1,000 Patient Days

WYN MAC WB DET

Quinolones Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

WYN 41.96 43.51 42.88 26.97 21.96 17.71 18.92 14.13

MAC 53.63 48.85 40.34 47.37 40.91 48.79 37.77 28.38

WB 37.64 32.74 34.81 28.5 30.26 27.81 17.86 16.05

DET 27.76 31.41 33.35 35.41 30.12 29.4 26.39 23.61

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0

50

100

150

200

250

300

350

400

450

500

Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

High Risk Antibiotics Days of Therapy/ 1,000 Patient Days

WYN MAC WB DET

67

141

145

742

43

99

277

471

198

0 100 200 300 400 500 600 700 800

Broaden therapy

Change empiric therapy

Change definitive therapy

De-escalation

Enforced restricted/monitored antibiotic policy

Initiate antimicrobial therapy

Other assistance with infectious disease management

Stop therapy; duration sufficient for infection

Stop therapy; no indication for antibiotic(s)

Number of Inventions Attempted

Antimicrobial Stewardship Interventions Attempted 09/2015 -10/2017 at HFWH

• Other stewardship activities not included above include antibiotic dosing and antibiotic allergy updates.

• Intervention acceptance rate is no longer tracked, but interventions had 85% acceptance rate during the

first 6 months of the antimicrobial stewardship program.

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Reduction in HA C. diff

Increased Hand

Hygiene Compliance

Focused Daily Post Huddles on HAIs

Proper Isolation

Antimicrobial

Stewardship

PDCA: Act

Continue post daily safety huddles to discuss new HAI

and opportunities for improvement

Partner with EVS to broaden targeted UV robot usage

Maintain a sense of ownership with a collaborative, non-

punitive environment among staff

Maintain high-level antimicrobial stewardship program

with continued support from leadership

System sharing of findings/ trends from Root Cause

Analyses

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PDCA: Act

KEYS TO SUCCESS AND LESSONS LEARNED

• The importance of a multi-disciplinary approach proved to be

invaluable to reduce HA C. diff.

• Opportunities to hear and share challenges from front line staff

proved to be an essential component to implementing process

improvements.

• Heighten awareness of front line staff and key stake holders help

promote and move forward all initiatives and improvements.

• Local in-house testing played a vital role in eliminating

inappropriate testing.

• Strong support from Senior Leadership and Physicians help drive a

culture change within HFWH.

Example #2

Delivering Safe and Patient Focused

Care Through the Reduction of

Catheter-Associated Urinary Tract

Infections (CAUTIs)

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The Challenge…

• Catheter-associated urinary tract infection (CAUTI) is the fourth most

frequent healthcare-associated infection

• Urinary catheter use in hospitals is common (12% - 16%)

• 3-7% increase risk of acquiring a CAUTI for each day an indwelling

urinary catheter remains in place

• Leads to:

– Unnecessary use of antibiotics

– Possibly an increase in hospital length of stay

– Increase in health care cost ($896/CAUTI)

• Our Goal:

– Achieve equal or better than the NHSN 25th percentile for catheter utilization

and CAUTI rate.

– Reduce urine culture utilization (cultures/100 catheter days)

Source: CDC.gov (https://www.cdc.gov/nhsn/PDFs/pscManual/7pscCAUTIcurrent.pdf)

CDDEP (https://cddep.org/tool/overall_and_unit_costs_five_most_common_hospital_acquired_infections_hais_us/)

PDCA: PLAN

ENGAGE

Key Stakeholders:

• Infection Prevention and Control

• Unit Champions (nurses, providers, patients)

• Pharmacy

• Data Analytics

• EMR

• Laboratory

• Senior Leadership

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PDCA: PLANEDUCATE

• Various methods (Healthstream, lectures, rounds, patient

education pamphlet) on:

• Indications for catheter placement and importance of early

removal

• Alternatives to urinary catheter

• Bladder bundle – care of catheter

• Mindful culturing

PDCA: PLAN

EXECUTE

• Epic build for indications for catheter insertion

• Best practice advisory for early removal

• Shift toward electronic surveillance

• Antimicrobial stewardship

• Mindful culturing*

• Alternatives to urinary catheters- identify, innovate and

trial -especially female external devices

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A Few Words Regarding “Mindful Culturing”

• Did we create this monster…

Fever = “pan-culturing”

• Take pause, asses for source of fever (blood/urine/gut)

• Urine that is cloudy / foul odor ≠ infection

• Asses where culture is (to be) taken from

– Urine: Foley bag vs straight cath?

– Blood: Central line or peripheral (i.e. line colonization)

– Stool: is patient on pro-motility agents? (i.e. are the laxatives

causing the diarrhea?)

• Repeating cultures to document clearance

PDCA: PLAN

EVALUATE

• Gap Analysis

• Root Cause Analysis

• Dashboard reporting with comparison to national

benchmarks

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PDCA: DO

PDCA: Check

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PDCA: Act

CAUTI

System sharing of findings/trends from Root Cause

Analyses to identify further opportunities for

improvement

18.7% decrease in CAUTI compared to 2015 rate, with

estimated 24 CAUTI’s avoided annually

Estimated cost savings in CAUTI avoidance = $24,000

annually

Sustained decrease in CAUTI’s over 18 months, nearing

goal of NHSN 25%ile

PDCA: Act

Urine Culturing

23.6% reduction in urine cultures ordered

compared to 2015 rate

Estimated cost savings in urine culture

avoidance = $27,000 annually

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Indwelling Urinary Catheter Patient

Information Guide

• 8 page guide for patients

• Patient Advisor was

invaluable to the success of the

team

• Provide insights from a patient’s

unique perspective

• Inform and empower patients

to:

– assure their catheter is

indicated

– cared for properly

– discontinued as soon as

possible

Henry Ford Health System’s

Progress with HAI Reduction

CAUTI CLABSI SSI COLO SSI HYST MRSA Bac. C. diff

2014 Total 167 27 27 5 19 338

2015 Total 137 98 14 3 14 294

2016 Total 111 58 22 5 32 253

2017 Total 60 45 20 5 30 237

2018 YTD 30 28 11 2 15 114 (YTD)

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Questions?